Choosing Wisely report

Echocardiograms for Valve Disease

When you need the test—and when you don’t

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Valve disease is caused by a heart valve that does not work properly. A test called an echocardio­gram can show how serious the problem is and if it is getting worse. But if your valve disease is mild, and it is not causing any symptoms, you probably don’t need to have the test every year.

Echocardiograms show pictures of the heart valves.

The heart has four valves. Each time your heart beats, they open and close. This keeps blood flow­ing through the chambers of your heart and to your body. If a valve does not work properly, blood can back up in one of the chambers. This puts stress on the heart and makes it harder for the heart to pump blood.

Valve disease is usually first found if your doctor hears a noise called a heart murmur during a routine exam. If you have a heart murmur, your doctor may order an echocardiogram. This will depend on the sounds the doctor hears.

An echocardiogram is a simple ultrasound that creates images of your heart. The images can show whether your heart valves are working properly and, if not, how serious the problem is.

Mild valve disease usually doesn’t cause problems.

Moderate or severe valve disease can lead to heart failure, stroke, blood clots, and other complications if left untreated. Mild valve disease, however, is not likely to cause complications. Often, it does not get worse, and if it does, this happens very slowly.

If you don’t have symptoms and your doctor doesn’t hear anything unusual, most likely your valve dis­ease is mild and not getting worse. Having an echo­cardiogram every year will not show anything new.

An echocardiogram could lead to other tests.

A standard echocardiogram is painless, safe, and does not expose you to radiation. But if the test doesn’t show enough images of your heart, your doctor might order an additional procedure, called a transesophageal echocardiogram (TEE). During a TEE, a flexible tube is guided down your throat and into your esophagus. It takes pictures of your heart from inside your esophagus.

Your throat may be sore for a few hours afterward, and in rare cases the tube can cause injury to the throat. You could also have a bad reaction to the medicine you are given to help you relax. This can include nausea and trouble breathing. You also have to fast before that test, and you may need someone to drive you home. Why risk having the second test when you don’t even need the first one?

An echocardiogram can cost you a lot.

A standard echocardiogram can cost $1,000 to $2,000, and a TEE can cost $2,000 or more, according to If you do not have health insurance, you may have to pay the whole cost yourself. And even if you have insurance, you usually have a co-pay. This can be as much as half the cost of the test.

When should you have an echocardiogram for valve disease?

Your doctor will likely order an echocardiogram if:

  • Your heart murmur is fairly strong.
  • Your doctor finds signs that your disease is getting worse, such as a change in the murmur.
  • You develop symptoms, such as unusual tiredness, shortness of breath, fever, chest pain, dizziness, or fainting; swelling in your ankles, feet, legs or abdomen; or a fluttering, racing, or irregular heartbeat.

You may need tests more often if you have mild valve disease and you also have other heart conditions, you have moderate or severe valve disease, or you have had a valve replaced.


This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment.  Use of this report is at your own risk.

© 2012 Consumer Reports. Developed in cooperation with the American College of Cardiology. To learn more about the sources used in this report and terms and conditions of use, visit